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My month as a "Guest Expert" on the WebMD Depression Community site is now at an end. It's a bit strange to be saying goodbye seemingly just as I was in the middle of my hello, but such is the way of short term participation.

I was glad to have the opportunity to share some ideas and perspectives. I was particularly interested in presenting some ideas beyond the many postings about medications, medication side-effects, medication dosages, medication withdrawal, medication switches and medications for improving medications.

I was amazed to see how adamant some people still are about the notion of depression being the result of a brain chemical imbalance despite no supportive evidence and growing contradictory evidence. The drug ads clearly work. I don't want to stop people from taking medications. I simply want to make the point that even when medications help with some symptoms, no amount of medication can help people be better problem solvers, which is necessary in dealing with life's challenges.

So, in this final post I want to point some things out that I hope will give people a boost in a helpful direction. Look over peoples' posts. So many of them say, in essence, "I can't deal with this." Whether referring to a depressed spouse, a depressed child, a death in the family, the stress of some troubling situation, too many people uniformly attribute their depression to being unable to cope.

My main point from my first entry on is that learning to cope is essential. If you feel you can't cope with something, that means you are missing the coping skills that would allow you to manage the situation more effectively, without sinking into depression. It doesn't necessarily mean the problem is unsolvable or unmanageable. It just means you don't know how to solve or manage it.

Psychotherapy with a really good therapist, experienced in treating depression and proactive in style, can teach coping skills. Medications can't. Waiting for the drug to work isn't coping. Trying another drug isn't coping, either. Wishing you were dead is the virtual opposite of coping- it's giving up. Don't!!

It requires a change of mind and heart to actively take the initiative to learn skills for managing life well, especially if you are convinced the problem is your biology and not you. There are lots of excellent books and websites that provide information and the means for developing the skills to move through the inevitable adversities of life. I have posted some of my favorites in the resources link.

Did you know that insomnia is the most common symptom related to depression? Insomnia can take several forms:having difficulty initially falling asleep or staying asleep, the latter manifesting as either middle of the night or early morning awakenings. Chronic insomnia sufferers report a decreased quality of life, loss of memory functions, feeling fatigued, unable to concentrate well, and diminished interest in socializing or engaging in pleasurable activities, further increasing depressive symptoms A sleep disturbance can increase the risk for alcohol-related problems. Survey respondents who reported sleep disturbances, more than 12 years later, had twice as high a rate of alcohol-related problems.

Interventions currently in use for treating depression-related insomnia fall into two general categories: medications and psychotherapy. Self-help strategies, including hypnosis (which I discussed in my last post), are a viable option.The use of self-help techniques for enhancing sleep offers several key advantages: Self-help will not lead to either drug addiction or dependence, it can be applied under all conditions, it is a low cost intervention, and it will not lead to potentially harmful interactions with other interventions.

Here are some things you can do to improve your sleep:

1) Do your best to get on a regular sleep schedule, going to bed and waking up at roughly the same time each day. This is the most important thing you can do.

2) Avoid caffeine (coffee, sodas, chocolate).

3) Avoid alcohol. For people who are depressed or are at risk for depression, alcohol is a very bad drug.

4) Many people who suffer insomnia go to bed and then start thinking about problems, engaging in rumination. Try and re-direct your thoughts by asking what you can actually do about the problems. It's easier to learn to let go when you are clear there's nothing to be done about some things and it's easier to feel empowered if you decide to take effective action when action is possible.

5) Enhance your skills in "time-organization" in order to better separate bed-time from problem-solving time.

6) Learn "mind-clearing" relaxation strategies, especially self-hypnosis strategies of one type or another. This is can be a HUGE help. You can easily make a recording to listen to at bedtime of your own voice calmly, slowly conducting a relaxation process, perhaps describing a good vacation in detail you once took or something similarly comforting. It will help re-focus you on relaxing and make it easier to drift off to sleep and to stay asleep.View Thread

A pattern that can keep people depressed is called "rumination," which refers to spinning around and around the same depressing thoughts over and over again. Having distressing thoughts is one part of the problem, but the bigger part of the problem is when people actually believe them. Thus, it may make sense to learn how to step back from your thoughts and let them float by without taking them in and believing them.

Mindful Meditation (MM) is a powerful means of evolving greater awareness and acceptance that has its roots in Buddhist traditions. Adapted by mental health professionals to help with depression, anxiety and other conditions, MM helps you learn how to focus your attention in meaningful ways. It helps you to redirect ruminative thinking into calming, relaxing images while also detaching from your thoughts as triggers for emotion. For example, a common imagery used in MM is to picture your thoughts as if fallen autumn leaves floating down a gentle stream. From a safe and comfortable distance, such imagery allows you to see your distressing thoughts ("I'm so screwed up!") go by in a detached way, thereby losing their power to make you feel bad. The thoughts can become objects of curiosity rather than triggers for bad feelings. In essence, MM teaches you to be aware of then accept and use your thoughts in new ways rather than fighting against them. Through calm, aware experience, you discover that you are more than your thoughts.

Hypnosis similarly involves a focusing process. People in hypnosis are highly attentive to a specific focal point, whether the soothing words of someone guiding them through the experience, or a specific idea, image, or symbol. It could be almost anything the person focuses on as a means of relaxing and getting absorbed in the experience.

Contrary to the common misconceptions that suggest people will have less control over themselves, in fact, skillful applications of hypnosis increase the degree of control people can attain over their experience. Of all the things I have studied in depth in my lifetime, I have been most impressed with hypnosis for its ability to help people develop greater self-mastery.

Modern clinical hypnosis has become a core component of behavioral medicine and psychotherapy programs all around the world because it can help you control your thoughts, feelings, behavior, and even the level of pain in your body.

Hypnosis is about building frames of mind. A qualified clinician (state licensed, academically trained health care professional) who uses hypnosis can teach key skills that can reduce anxiety and depression. The experience of hypnosis is relaxing, and people in hypnosis hear and can respond to anything and everything going on. They are active participants in the process, and can more easily absorb new ideas and learn helpful skills when in that relaxed, focused state.

Someone replied to my last post by advancing the notion that depression is caused by brain damage. That isn't true, nor does it help people to think of depression being caused in this way. Interestingly, though, the evidence is growing that both MM and hypnosis do actually help change brains as well as minds through the processes of neurogenesis (producing new brain cells) and neuroplasticity (brain adaptations to novel conditions). Creating deliberate experiences that retrain your brain are sensible treatments, and provide yet another reason for being positively action-oriented.

Here's a link to the American Society of Clinical Hypnosis website for anyone interested in obtaining a local referral for a professional who does hypnosis: www.asch.net .

I'd also suggest reading The Mindful Way Through Depression by Williams, Teasdale, Segal & Kabat-Zinn.View Thread

Do you ever wonder what makes for healthy, strong, happy people? Or why some people face stressful and challenging events in life and seem to rise above them, while other people implode in the face of what seem like routine stressors?

The vast majority of research into depression has focused on the pathologies within people that presumably give rise to the disorder, such as character defects, anger-turned-inward, unresolved childhood issues, distorted thinking, and chemical imbalances in the brain. Only recently has there emerged a different paradigm for thinking about human experience. Known as positive psychology, its focus is on what is right with people rather than on what is wrong. Instead of studying people who suffer, positive psychologists study people who have overcome adversity and thrived, who became happy, competent, and fulfilled. Positive psychology strives to identify their strengths in order to better help those who are suffering.

One of the first tasks positive psychologists attempted was the development of a new manual that would catalogue and define many of the best aspects of human experience. Unlike the well-known psychiatric manual listing various forms of psychopathology (called the Diagnostic and Statistical Manual, now in its revised fourth edition, DSM-IV-R) used by the mental health profession to diagnose patients, a new manual called Character Strengths and Virtues was developed by psychologists Chris Peterson and Martin Seligman to identify and describe some of the best human attributes. These include the courage to speak the truth, kindness, love, fairness, leadership, teamwork, forgiveness, modesty, gratitude, and many other such positive characteristics. If you re-read these attributes, you cannot help but notice that these are wonderful human potentials that can only be expressed in the context of human relationships. Simply put, how people develop their best selves is largely, though not entirely, achieved in the context of positive relationships with other people.

Other people provide support and alternative points of view. When I read some of the postings on WebMD, I am really heartened by how much sensitivity and compassion there can be in someone's reply, even as they offer a different point of view. That's wonderful! And, it's essential as a first step to begin recognizing that sometimes we think and feel things that are so subjective that, from within those thoughts and feelings, we trap ourselves. In the scientific literature, this is known as an internal orientation; People use their own feelings and experiences to interpret and react to the world around them, and don't realize their perceptions of what's going on are "off the mark."

Your experience will necessarily be different from that of others. A great question, one Positive Psychology strives to answer, is, "How can we learn from the people who do this (whatever "this" might be) well? For me, it has been about striving to better understand how some people recover from depression, how they bounce back from trauma and adversity, and how they build increasingly satisfying lives despite having suffered. The awareness is growing that there are specific skills - learnable skills- that go into living well.

What do YOU think allows people to overcome adversity? You might want to reply to the poll question below if you have time to do so.View Thread

I appreciate each of you taking the time to reply to my post. It's true that I'm not a big fan of antidepressants, but neither am I against them or suggesting people shouldn't take them. When people talk about how these medications saved their lives, I believe them. However, each of us needs to be aware that what works for us on an individual basis may not be helpful to others.

Even though antidepressants have helped some peope, there are problems with them that need to be acknowledged and, hopefully, eventually resolved. Some of those problems will not be possible to resolve, though; addressing the social and psychological factors in depression can't be accomplished with a medication. It's the wrong tool for the job.

One of the most important concerns I have is that people are led to believe depression is all about a biochemical issue that only the drug will address. As I've stated, there are many contributing factors to depression, many of which are not biological.

Depression is built on a foundation of passivity; too often, people don't take the steps needed to truly help themselves, believing hopelessly their effort wil be wasted. Just telling someone to take a drug without also advising the importance of actively learning specific skills to help cope and also reduce one's vulnerabilities to depression is what I take issue with. A doctor can unintentionally reinforce passivity by indirectly suggesting to the patient, "you don't need to learn anything new or do anything differently, all you need to do is take the drug on time." This is a likely contributor to depression's higher rate of relapse when all someone does is a take medication compared to when they also enter structured skill-building psychotherapies.

Antidepressants can help, but there are many other approaches, including physical exercise and skill building psychotherapies, that match and even exceed the success rates of antidepressants. Instead of people believing it's all about drugs and biochemistry, I hope to promote a more multi-dimensional view through my postings.Treating a problem with a huge social component on an individual basis with drugs alone assures the problem will continue to grow, just as it is now.

Antidepressants are the most popularly prescribed class of drugs in the United States. Is that because of good science--- or good marketing? Reading the posts here on WebMD by some, the hopefulness for a drug solution is a common theme. Recently, however,a flurry of books and articles have directly challenged antidepressants, suggesting they pose little benefit beyond placebo.

Just 2 weeks ago, a new review called "Efficacy and Effectiveness of Antidepressants " by H. Pigott et al. was published in Psychotherapy and Psychosomatics. It involved four meta-analyses of efficacy trials submitted to the FDA and suggested that ADMs are only "marginally efficacious" compared with placebo, showing "a sustained benefit only 2.7% above placebo."

The Emperor's New Drugs: Exploding the Antidepressant Myth, by Irving Kirsch, Ph.D., is a new book providing a detailed accounting of the huge controversy he sparked by suing to obtain the hidden data about antidepressant medications. Kirsch created an uproar when he added back in the negative data the drug companies had hidden from view while shamelessly promoting drugs they knew were little better than placebos. Kirsch was interviewed by Newsweek magazine in the February 8th issue (see the lead article "The Depressing News About Antidepressants " by Sharon Begley). This was the first time the general public was alerted to the issues raised by Kirsch and many others who also revealed the misdeeds of BigPharm.

When so many people rely on these medications, experts don't take it lightly to raise questions about them. No one who devotes their career to studying depression and who wants to help people seeks to undermine a potential solution. But, it has become increasingly apparent over the years that the promise of antidepressants has become a marketing tool more than a genuinely effective treatment. Just taking medications is not likely to be enough of an intervention for most people. The importance of learning specific skills known to reduce - and even prevent - depression is more apparent than ever and will be the subject of future blogs.

It is vitally important to be realistic about what medications can and cannot do in helping people overcome depression. When you hear about new research like this, does it affect your views about antidepressants?

Depression is a multi-dimensional disorder. It has biological components based in genetics, neurochemistry and physical health. It has psychological components that involve many individual factors such as cognitive style, coping style, and qualities of personal behavior. And, it has social components, factors that are mediated by the quality of one's relationships. This includes such variables as the family and the culture one is socialized into, and one's range of social skills. Thus, the best, most accurate answer to the basic question, "What causes depression?" is, "Many things." Likewise, the way out of depression has many different paths, and each person's path will uniquely be his or her own.

The fact that there are many different factors contributing to depression is important to know. Not all the factors are equal in weight- some exert a greater influence than others in specific people. Some exert a great deal of influence that is only now starting to be realized. The social side of depression is especially important, yet is terribly under-considered in most people's awareness.

We know, for example, that depression runs in families: The child of a depressed parent is anywhere from three to six times more likely to become depressed than the child of a non-depressed parent. The genetics research makes it quite clear that it isn't entirely — or even mostly - faulty genes responsible, especially we now know since there is no "depression gene." As genetics expert Kenneth Kendler, M.D., said, 'There aren't genes that make you depressed. There are genes that make you vulnerable to depression."

For most of us, the development of depression has more to do with the patterns of thinking, coping, behaving, and relating that we learn through socialization from parents (and other significant influences in our society) through daily interaction than it does one's genetic makeup. Consider this unfortunate evidence: When you have the largest demographic group of depression sufferers, the 25-44 year olds, now raising children, it should surprise no one that their children are the fastest growing group of depression sufferers. Kids are stressed in ways now that previous generations of kids were not, and they're having difficulty coping. And, realistically, parents can't teach their children what they don't know in terms of coping well with their kids' stressors. As just one example, how many parents know what to do when their kids are being bullied on Facebook or Twitter? How many even know how Facebook and Twitter work? It is a rapidly changing world, in social terms, and the rising rates of depression in all age groups reflect that fact. Learning new ideas and skills to better manage the new challenges we face is essential, as I will continue to explore in future posts.

What do you think? Can you identify changes in our social world that might contribute to the increased rates of depression? Any ideas what might be done to help?View Thread

Hi and welcome! I'm Dr. Michael Yapko. I'm so pleased to be serving for this month as a "guest expert" for the WebMD Depression Community. I'm excited about this venue for sharing information and perspectives about depression and the work I've been involved in for more than three decades. I'm a clinical psychologist and author of a dozen books, and I regularly conduct clinical trainings for mental health professionals all around the world, particularly in the areas of short term psychotherapies and the active treatment of depression. I hope to bring practical, helpful information and viewpoints to this community, perhaps one that may at times seem a bit challenging to some with a different viewpoint, but viewpoints that are well supported in the research nonetheless. I take the topic of depression extremely seriously, and am earnest about being well informed in what I write and teach. If you care to, you can learn more about my work by visiting my website: http://www.yapko.com ..
Depression gets a huge amount of attention but, in my opinion, it has been too heavily weighted in the biological direction. Advances in the study of the brain are compelling, to be sure, but what's especially interesting, to me at least, is that the more we learn about the brain and mind, the more we learn how important our relationships are in shaping our experience - including our vulnerability to depression.
We are routinely bombarded with ads for drugs that inform us depression is a "medical illness" caused by a neurochemical imbalance in the brain, as if this were an established and universally accepted fact. It isn't. I realize this is the WebMD website where a medical viewpoint tends to dominate. Recently, however, unintended negative consequences of seeing depression as a medical illness requiring medication have started to come to light, encouraging us in the mental health profession to reconsider conventional wisdom. I will present a broader view of depression in my entries here as well as in my replies to some of the questions and concerns that arise in our discussions. I will often draw attention to the growing evidence that depression is much more a social than medical problem. The spread of depression across age and demographic groups in this country, indeed around the world, is a direct consequence of complex social forces that deserve our recognition and careful consideration. In a social sense, depression is contagious.
When the quality of our relationships is so powerful in influencing how we look at ourselves, others, life, can drugs really be the sole or even primary solution? We can't medicate everyone, realistically, and even if we could, the reality is that medication has too many limitations associated with it that unintentionally actually further exacerbate the problem. Suffice it to say for this first entry that depression is too serious and complex a problem to be dealt with only one-dimensionally. It's true- you are much, much more than your biology alone. How you relate to others is a great predictor of how you feel. In future entries, I'll focus on some of the specific evidence for the points I'm making in this general introduction to what my work in the area of depression has been about.
This WebMD Depression community represents, to me, a part of the solution- getting involved with others in helpful and supportive ways, sharing experiences and opinions, being willing to inspire and be inspired. I look forward to this month of participating in this community, and hope my contributions will be meaningful.
To get the conversation started, I'd be interested in hearing people's reactions to some of my comments. What does it mean to you to hear me say you're much more than your neurochemistry? Do you have an opinion as to how much of depression arises through social causes? What social changes do you think may have contributed to the escalating levels of depression?View Thread